Effectiveness of second-look endoscopy after gastric endoscopic submucosal dissection in patients taking antithrombotic agents: a multicenter propensity score matching analysis

Taro Iwatsubo, Toshihisa Takeuchi, Akitoshi Hakoda, Yasuhiro Fujiwara, Yasuaki Nagami, Yuji Naito, Osamu Dohi, Tetsuya Tatsuta, Manabu Sawaya, Xiaoyi Jin, Tomoyuki Koike, Mitsushige Sugimoto, Masaki Murata, Kenta Hamada, Hiroyuki Okada, Hideki Kobara, Taiga Chiyo, Norimasa Yoshida, Naoya Tomatsuri, Tomoki InabaShigenao Ishikawa, Akihito Nagahara, Hiroya Ueyama, Eriko Koizumi, Katsuhiko Iwakiri, Kazuhiro Mizukami, Kazunari Murakami, Takahisa Furuta, Takahiro Suzuki, Naotaka Ogasawara, Kunio Kasugai, Hajime Isomoto, Koichiro Kawaguchi, Kotaro Shibagaki, Hiromi Kataoka, Takaya Shimura, Hidekazu Suzuki, Toshihiro Nishizawa, Kazuhide Higuchi

Research output: Contribution to journalArticlepeer-review

Abstract

Background: The risk of bleeding after gastric endoscopic submucosal dissection (ESD) in antithrombotic agent users has increased, and its management remains a problem. Second-look endoscopy (SLE) following gastric ESD in antithrombotic agent users may be effective in preventing delayed bleeding, but this requires elucidation. Therefore, this study aimed to investigate the efficacy of SLE in reducing bleeding after gastric ESD in patients receiving antithrombotic agents. Methods: This retrospective cohort study was conducted at 19 referral hospitals in Japan. A total of 1,245 patients who were receiving antithrombotic agents underwent gastric ESD between January 2013 and July 2018. The incidence of delayed bleeding was compared between SLE and non-SLE groups using propensity score matching analysis. Results: Overall, 858 patients (SLE group, 657 patients; non-SLE group, 201 patients) were analyzed. After matching, 198 pairs were created. Delayed bleeding occurred in 10 patients (5.1%) in the SLE group and 16 patients (8.1%) in the non-SLE group [odds ratio (OR) 0.605, 95% confidence interval (CI) 0.23–1.46, p = 0.310]. In the subgroup analysis, SLE reduced the incidence of delayed bleeding in patients receiving heparin bridging therapy (6.3% and 40.0%, respectively; p = 0.004). In the SLE group, prophylactic coagulation did not significantly reduce delayed bleeding compared to the no treatment group (14.6% and 8.6%, respectively; p = 0.140). Conclusions: SLE was ineffective in reducing bleeding after gastric ESD in antithrombotic agent users, overall. A prospective comparative study is warranted to definitively evaluate the effectiveness of SLE in reducing bleeding in high-risk patients.

Original languageEnglish
JournalGastric Cancer
DOIs
Publication statusAccepted/In press - 2022
Externally publishedYes

Keywords

  • Antithrombotic drug
  • Bleeding
  • Endoscopic submucosal dissection
  • Retrospective cohort
  • Second-look endoscopy

ASJC Scopus subject areas

  • Oncology
  • Gastroenterology
  • Cancer Research

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